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REMIT TO: REGIONAL INCOME TAX AGENCY - P.O. BOX 477900 BROADVIEW HEIGHTS, OHIO 44147-7900

FORM 17 - RECONCILIATION OF INCOME TAX WITHHELD

AND

W-2 TRANSMITTAL

A Reconciliation of Income Tax Withheld is required to be filed on or before the last day of February following the calendar year

in which employee withholding deductions have been made by an employer. For assistance please call one of the following:

Cleveland Local: (440) 526-0900, Columbus Local: (614) 538-0512, Youngstown Local (330) 743-3400, TDD: (440) 526-5332,

or Toll Free: 1-(800) 860-RITA (7482). Our website is

1. Print the company’s federal employer identification number, name, and address in the proper area. If this information is

preprinted, check for accuracy. Draw a line through any incorrect information and print the correct information above or below it.

2. List the amount of workplace wages, workplace tax, and any residence tax withheld for each period a Form 11 was filed. For Example:

If you file Form 11 monthly, complete the annual Form 17 on a monthly basis; periods 1-12. If you file Form 11 quarterly, complete the

annual Form 17 on a quarterly basis; periods 3, 6, 9, 12. NOTE: Wages do not need to be reported for residence tax withheld.

3. Indicate the total number of W-2’s attached and indicate the total number of employees working at year end for which municipal income tax

has been withheld in the boxes provided in Section 3. Distribute the total number of employees to each municipality where the employee

worked in Section 5.

4. Total the workplace wages, workplace tax, and residence tax withheld. These amounts must be distributed on the back side of

Form 17.

5. Distribute totals to each municipality where the wages were earned and the workplace or residence tax was withheld.

6. Total all distributions. THE TOTAL WORKPLACE WAGES, WORKPLACE TAX, AND RESIDENCE TAX WITHHELD IN SECTION 6

MUST EQUAL THE TOTALS SHOWN ON THE FRONT SIDE OF THE FORM 17 IN SECTION 4.

7. Indicate the total number of employees at year end for all municipalities.

8. Sign and date the form. Please provide a phone number where you can be reached if any questions arise.

DO NOT REMIT PAYMENT WITH THIS FORM. IF YOU ARE ADJUSTING A PERIOD(S) YOU MUST FILE A FORM 11A

(AMENDED EMPLOYERS MUNICIPAL TAX WITHHOLDING STATEMENT). SEE FORM 11A FOR INSTRUCTIONS.

Along with Form 17, one of the following must be submitted:

•

Copies of W-2’s

•

Upon written request made to the Tax Administrator on or before the due date-

• Computer paper listing which must contain the following information from each W-2 (in this order) social security number, municipality for which

local income tax was withheld, amount of local income tax withheld, gross amount of taxable compensation paid, employee’s name (last, first,

middle), and employee’s last known address; or,

• W-2 Copy 1 for state, city, or local tax departments.

• Employers with 250 or more W-2 Copy A or 1099-Misc. Forms must report on Magnetic Media using (MMREF-1) Format and Guidelines

prescribed by the Social Security Administration and Internal Revenue Service.

• MMREF-1 Guidelines can be found and printed by using the Social Security Administration Internet Page

• 1099-Misc. Form Guidelines can be found and printed by using Internet Page using Keyword pub 1220.

• RITA guidelines for the RS Record (CITY AND STATE) found within the SSA MMREF-1 Guidelines, can be found and printed by using Internet

Page and clicking on MAGNETIC REPORTING OF W-2’s BY EMPLOYERS.

• Please be advised that you are required to validate your MMREF-1 file containing W-2’s by visiting our website: and using

R.I.T.A.’s online W-2 verification application.

• This online application will parse and validate your MMREF-1 file containing W-2’s to ensure compliance with R.I.T.A.’s specifications and

requirements.

• Any exceptions such as computer or typewriter listings of municipality wage and tax information, in lieu of the standard W-2 Form, or paper W-2 reporting

for more than 250 employees, must receive prior permission from the RITA Director of Taxation or the Tax Administrator where the

business is located, before submission of such lists or forms.

• Please do not password protect W-2 files sent to RITA.

• Tax Year 2005 was the last year we accepted diskette submissions.

All of the above must contain the federal employer identification number, the company name, and the address.

NOTE: Employer’s required under the Internal Revenue Code to furnish 1099’s to the Internal Revenue Service for individuals or businesses to whom they have

paid non-employee compensation must also furnish copies to RITA. Submit 1099’s along with W-2’s.

NOW AVAILABLE...

THE REGIONAL INCOME TAX AGENCY NOW HAS AN ELECTRONIC FILING SYSTEM THAT IS A CONVENIENT

WAY TO FILE AND PAY YOUR EMPLOYER’S MUNICIPAL TAX WITHHOLDING STATEMENT (FORM 11) AND

YOUR RECONCILIATION OF INCOME TAX WITHHELD (FORM 17). IN ADDITION, YOU CAN ELECTRONICALLY

SUBMIT YOUR W-2’S. PLEASE BE ADVISED THAT YOU ARE REQUIRED TO VALIDATE YOUR MMREF-1

FILE CONTAINING W-2’S USING R.I.T.A.’S ONLINE VERIFICATION APPLICATION.

IT IS A FREE SERVICE THAT PROVIDES A FAST AND SECURE METHOD OF FILING.

Instructions For Form 17 - Reconciliation Of Income Tax Withheld W-2 Transmittal - 2006

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